We need a people-powered ‘digital dynamic’ for digital health

Engaging clinicians and patients in the design and delivery of digital health is essential if we are to create a digital dynamic that enhances the use of the technology in healthcare, says Martin Bell, the former deputy managing director at EMIS Health and director of IM&T at North Bristol NHS Trust.

Touring the country and having conversations with people across the digital healthcare landscape, I’m struck both by the scale of opportunity, and the scale of challenge in engaging the population in healthcare, and making more healthcare services digital, or at least digitally-enabled.

News headlines focus on the operational, clinical and financial pressures facing the NHS. Opinions on solutions seem to become more polarised as the debate rages. Regional programmes in England, such as the sustainability and transformation programmes (STPs), continue apace and pursue an integrated care agenda. However the Nuffield Trust has published a report suggesting that there was little financial evidence to support the move from acute to community based care (although surely it’s the right direction of travel?).

Meanwhile, the INTEROP summit in London has pushed forward the drive for greater interoperability, the government has launched a new digital strategy for the UK, the Global Digital Exemplar (GDE) programme grows and moves forward in England, and there is a feeling of positive investment into the digital economy of healthcare – albeit, more would always be welcomed.

Health and social care are urged to come together, yet it is still unclear how policies that require competition in clinical service tenders sit in that new or revisited world of closer working between organisations.

It is a massive agenda, and those who work in the NHS deserve our praise for continuing to progress through that massive agenda.

More specifically, in the context of this piece, the digital leaders in all their guises who straddle the NHS IT agenda, in all its beautiful shapes and sizes, deserve the support – and thanks – of the whole health and care ecosystem.

The current situation has led me to consider some key questions:

• What can government and national policy do to encourage greater digital take up around health, within the UK population?
• How can STPs (perhaps via their local digital roadmaps – LDRs) address digital healthcare engagement and use it as part of their plans to reshape healthcare services. How many STPs have digital included already? And what if they don’t?
• And for healthcare IT – if one presumes that electronic patient record systems will continue to emerge increasingly routinely over the coming 5-10 years, how can healthcare IT engage the patient, as well as the clinicians?

I don’t necessarily have answers!

The UK digital strategy needs to encompass healthcare
National policy certainly has a role to play in driving public perception, participation and physical engagement. But how can policy drive beyond those who might naturally use apps because they have an interest in fitness or diet, and get the broader community engaged? How can we ensure that online health – whether it is simple appointment booking to save time, online triage of conditions, or ongoing monitoring of long term conditions – is readily available for all?

Perhaps the new UK digital strategy, and the hours of training promised by private companies from banks to “big tech giants”, could include health (perhaps along with education) as core elements of the curriculum to ensure that these things could help the population’s health. This could also start to relieve some of the pressures on healthcare services for the future. The digital strategy aims to give everyone access to the digital skills they need. How far does this extend to healthcare?

Picking up on the accreditation discussion the likes of the BCS and digital leaders such as Andy Kinnear from the Bristol health community have been having around healthcare IT, and building on the recommendations of the Wachter review, could we consider certificates, awards, badges, and more, to support interest in digital learning amongst the wider population?

Do we need to ensure that health is linked in with technology in our schools, so the next generation just blend it in to their daily diet of digital activity? It’s something different, something to be encouraged, so that it is part of a new digital dynamic that needs to emerge.

Whilst the NHS implements increasingly digital services – and it must – creating the ground swell from the population can only increase take up and re-invention around digital services. Yet all involved in technological change know that including the end users in the design of digital services can greatly increase chances of eventual adoption. The public need to be involved in the creation of the UK digital strategy, as much as clinicians and patients need to be included in local digital plans for healthcare.

How can we ensure the public are engaged?
The plans for local areas in England via STPs, or in any of the other UK nations, are all looking at how healthcare can be reshaped, and delivering more (or perhaps the same) with less. If coping with demand, engaging with the public and delivering improved outcomes does not include digital – whether more traditional IT, current ‘apps’ or future virtual reality – how can those plans be sustainable for the future?

Every industry throughout history has re-cast itself for the future, adopting the latest and adapting to future technology, to move itself forward. Reshaping healthcare needs to embrace and utilise, at scale and at speed, all available technology. Using such technology might also help with perceptions amongst the public that some planning doesn’t involve them.

Reshaping healthcare through technology needs to cover the excellent work of those involved, for example, in the INTEROPen interoperability initiative, NHS and suppliers. But it also needs to extend beyond those involved in or interested in IT and digital, to all other clinicians and managers. We can use technology to transform what we do, to make things easier for clinicians, and make things better for the patient, in terms of both experience and outcomes.

Whenever an STP is written, a new model of care considered, or any investment planned – should not a ‘digital first’ check be built in? Do we need public, patient, carer advocacy to ensure it is? Just a thought…

Digital leaders need to seize the opportunity
Healthcare IT professionals have a tough challenge. Whilst targets, such as becoming fully paperless by 2018, may have been lifted for now, digital leaders have to balance the delivery of services today, the implementation of systems to support their organisations for tomorrow, and then consider how they can best serve their communities to bring them the relevant services that will help support a shift to more digitally-delivered healthcare.

Those digital leaders are not just the CIOs or the CCIOs across the UK. Every senior person in healthcare – NHS or private, clinical or not, customer or supplier side – needs to take on the challenge of being a digital leader, working together to create a digital landscape that truly meets the needs of tomorrow’s patients, carers and the public at large.

Many have already. But one can’t help feel still that service transformation, changes, new plans, strategies, and new models of care, do not always make full use of what is available digitally, and hook patients and clinicians into that digital dynamic.

Do we need some patient CIOs or digital leaders who are formally charged with representing the voice of the public, patients and carers? After the CCIO, why not the chief patient information officer?

A digital dynamic can help address the challenges facing healthcare
Galvanising that digital dynamic to bring all of the population in to the fold, or as much of the population as one ever is going to, would create such dynamic change. It would get them using their smartphones for healthcare in ways that are as common and as frequent as for Facebook, Snapchat, Twitter, online betting, train travel, holidays, or concert tickets.

Above all, if we are to use technology to address the opportunities and challenges facing healthcare, we need to drive a digital dynamic that encompasses as many as possible in its wake.