Technology in healthcare: How can we best meet the population’s needs?
by Dr Taufiq Khan
Technology has transformed the way we live our lives. People are becoming increasingly technology literate aiding several aspects of their everyday lives. Technology has already revolutionised the experience between service providers and consumers in industries such as banking and retailing. However, the same progress has not been seen within the healthcare sector and the difference between the digital experience we have as patients and what we have as consumers is at risk of becoming increasingly stark. Much work has been done in recent years by policy-makers and an increasing number of healthcare professionals to address this gap. The hope is that the appropriate use of technology will enhance efficiency and co-ordination of care, improve patient outcome and transform patient experience of healthcare in an atmosphere of increasing expectations.
The potential for technology to bring about a fundamental change in healthcare has already been shown. One study published in The Health Service Journal outlined the role of technology in implementing new models of care and fostering a culture of innovation1. Technology may also better capture data which can be used to help improve service planning and better ensure capacity is able to meet population demand2. Additionally, Mckinsey and Company, a management consultancy firm, showed that modernising health systems may produce savings of 11% of total health expenditure per year3.
The majority of GP practices have already gone ‘paperless’4 and the NHS ‘Five Year Forward View’5 has targeted 2020 as the point where the NHS will be entirely digital. Despite the growing ambition to embrace and utilise technology to improve healthcare, we must be wary of the challenges faced and past failures. Indeed, the healthcare sector has struggled with adopting technology with perhaps the most notorious example being the £10 billion National Programme for IT (NPfIT) failure to create an integrated electronic health record system across secondary care4. We must identify how best to adopt technology in order to improve the healthcare we provide for patients.
The Need for Interoperability
Interoperability is the ability of different IT systems across different organisations to share information in order to effectively advance delivery of care to patients6. The Five Year Forward View set a target of all electronic health records to be interoperable and in real time by 20207. This has proven difficult so far due to the complexity and variety of the systems currently in place in the NHS. This is particularly a problem in acute trusts as they are less ‘digitised’ and thus less able to share information (Figure 1)8. It is important to achieve interoperability as it is a fundamental building block for the NHS to see its digital strategy through. Moreover, several different specialities use different recording systems when encountering their patients creating multiple different systems leading to a fragmented picture. This is becoming more common as patients are increasingly seeing a range of healthcare professionals, particularly with the increasing prevalence of chronic disease9. Professor Robert Wachter, an expert on the challenges of digitisation in healthcare, was commissioned by the Secretary State for Health in 2015 to lead a review of the implementation of information technology. The subsequent report concluded that widespread interoperability would require development and implementation of standards with penalties for those not meeting the required standards4. There should also be a commitment to innovation with avoidance of any one supplier dominating the market. The Wachter Report also recommended that efforts for interoperability should be sensitive to local priorities with active consultation with local citizens and communities. With the appropriate funding and professional buy-in, the prediction is that national interoperability should be achieved by 2022.
Figure One – The availability of patient notes in digital format across various different trusts8
Patient Focused Technology
Technology must of course be directly focused on patients in order to improve health on a population level. Patient focused technology can improve patient engagement and experience and comes in a variety of forms.
One such example is the use of smartphone health apps. There are over 165,000 health-related apps available to download10. Two-thirds of these apps relate to general health and how to stay healthy2, this is particularly important given the increasing importance of preventative medicine. Healthcare apps can improve diet management11, promote physical activity12 and improve adherence to medication13. In order for healthcare apps to have the best chance of meeting the needs of the population, future work must focus on ensuring healthcare apps are fully accredited and do not breach privacy laws14. It is also essential that apps are user friendly and wherever possible, patients should be consulted in the design process2. Apps have a potentially important role to play, particularly if they succeed in meeting the Secretary of State for Health’s ambition that 15% of patients routinely access NHS services via apps15.
Telehealth is another example of how technology can be used to best serve patients. Telehealth refers to the remote exchange of data between a patient and their healthcare professional8. This may involve telephone, video or email and allows the patient to be in contact with a healthcare professional from their home. Video consultations in particular have been shown to be convenient and flexible for patients16. One review however found no effectiveness with telehealth17 whilst some unpublished data presented on social media revealed video consultations widen inequalities of access in secondary care18. There are also limitations such as difficulties in assessing mental health, inability to perform a physical examination and concerns surrounding data protection. However, telehealth has a potentially important role to play and research needs to identify which subsets of patients will benefit most, e.g. those with mobility issues (case study one, figure 2)2.
Figure Two – Case study of the use of ‘Skype’ in a Manchester general practice2.
We also need to increase uptake of patients accessing their medical records online. 95% of GP practices offer online access to health records19 but less than 1% have accessed their online record20. It is important to increase awareness as evidence shows that patients who access their online health record are more likely to have a sense of involvement in their own care21, better adherence to lifestyle advice and improved satisfaction22.
Monitoring technology such as Fitbit devices also promises to play a role in the future and has already been shown reduce admissions in those with chronic disease2, reduce mortality in heart failure23 and improve clinical outcomes in hypertension24.
Ventures into new and exciting technologies such as nanotechnology, artificial intelligence, wide genome sequencing and virtual reality have the potential to revolutionise treatment as we know it25. Such innovations need to be encouraged and built upon in order to improve the health of the general population.
Addressing Data Security Concerns and Digital Exclusion
Technology has the potential to capture vast amounts of information. A significant proportion of this information is likely to be patient sensitive and may additionally be used for secondary purposes – this is information which may be used for other purposes not directly linked to the care of the individual patient such as risk management, service planning and health outcomes8. This can mean patients may be wary of data handling, particularly after the recently well publicised NHS cyber attack26. A recent Caldicott review made a series of recommendations which aim to improve data security and increase public confidence27.
Twelve million people in the UK lack basic IT skills28. A significant proportion of these people will be high users of health services. Engaging these people in health-related technology will require a multi-faceted approach if we are to bring the best for our patients whilst adopting technology.
Technology has the potential to transform our healthcare system into one that is co-ordinated, innovative, proactive and one that ultimately brings the best care possible to our patients. For this potential to be realised, the entire workforce need to be encouraged and involved so that an increasing number of patients can be engaged with technology enabled services. Local leaders with knowledge of medicine and technology promise to have an important role to play in fulfilling this ambition.
- Ham C, Dixon A. The King’s Fund. Fixing the broken system. Available from: https://www.kingsfund.org.uk/publications/articles/fixing-broken-system. [Accessed 23rd September 2017].
- Castle-Clarke S, Imison C. Nuffield Trust. The digital patient: transforming primary care? Available from: https://www.nuffieldtrust.org.uk/files/2017-06/1497259872_nt-the-digital-patient-web-corrected-p46-.pdf. [Accessed 17th September 2017].
- McKinsey & Company. Health systems: Improving and sustaining quality through digital transformation. Available from: https://www.mckinsey.com/business-functions/digital-mckinsey/our-insights/health-systems-improving-and-sustaining-quality-through-digital-transformation?cid=digistrat-eml-alt-mip-mck-oth-1608. [Accessed 18th September 2017].
- Wachter RM. Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England. Report of the National Advisory Group on Health Information Technology in England. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/550866/Wachter_Review_Accessible.pdf. [Accessed 18th September 2017].
- NHS England (2016). General practice forward view: April 2016. https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf. [Accessed 20th September 2017].
- What is Interoperability? http://www.himss.org/library/interoperability-standards/what-is-interoperability. [Accessed 14th September 2017].
- NHS England (2015). Digital health services by 2020: delivering interoperability at point of care to support safe, effective, efficient and high quality care. Available from: england.nhs.uk/2015/03/boardmeet-26-mar15/. [Accessed 17th September 2017).
- Honeyman M, Dunn H, McKenna H. The King’s Fund. A digital NHS? An introduction to the digital agenda and plans for implementation. Available from: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/A_digital_NHS_Kings_Fund_Sep_2016.pdf. [Accessed 12th September 2017].
- Van Oostrom SH, Gijsen R, Stirbu I, Korevaar JC, Schellevis FG, et al. Time Trends in Prevalence of Chronic Diseases and Multimorbidity Not Only due to Aging: Data from General Practices and Health Surveys. Plos One. 2016; 11 (8): 1-14.
- Aitken M, Lyle J. IMS Institute for Healthcare Informatics. Patient adoption of mHealth: Use, evidence and remaining barriers to mainstream acceptance. Available from: http://www.imshealth.com/sites/en/auxiliary/404. [Accessed 12th September 2017].
- DiFilippo KN, Huang WH, Andrade JE, Chapman-Novakofski KM. The use of mobile apps to improve nutrition outcomes: A systematic literature review. Journal of Telemedicine and Telecare. 2015; 21 (5): 243-53.
- Casey M, Hayes PS, Glynn F, O’Laighin G, Heaney D, et al. Patients’ experiences of using a smartphone application to increase physical activity: the SMART MOVE qualitative study in primary care. The British Journal of General Practice. 2014; 64 (625): 500–8.
- Dicianno BE, Fairman AD, McCue M, Parmanto B, Yih E, et al. Feasibility of using mobile health to promote self-management in spina bifida. American Journal of Physical Medicine & Rehabilitation. 2016; 95 (6): 425–37.
- Huckvale K, Prieto JT, Tilney M, Benghozi PJ, Car J. Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment. BMC Medicine. 2015; 13: 214.
- National Information Board. Health Secretary outlines vision for use of technology across NHS. Available from: https://www.gov.uk/government/news/health-secretary-outlines-vision-for-use-of-technology-across-nhs. [Accessed 23rd September 2017].
- Fatehi F, Martin-Khan M, Smith AC, Russell AW, Gray LC. Patient satisfaction with video teleconsultation in a virtual diabetes outreach clinic. Diabetes Technology & Therapeutics. 2015; 17 (1): 43–8.
- Armfield NR, Gray LC, Smith AC. Clinical use of Skype: a review of the evidence base. Journal of Telemedicine and Telecare. 2012; 18 (3): 125–7.
- Greenhalgh T. Twitter. 2017. Available from: https://twitter.com/trishgreenhalgh?lang=en. [Accessed 7th November 2017].
- NHS England. Over 55 million patients in England set to benefit from accessing their GP record online. Available from: https://www.england.nhs.uk/2016/07/gp-records-online/. [Accessed 24th October 2017].
- Ipsos MORI. GP Patient Survey – national summary report. Available from: https://gp-patient.co.uk/surveys-and-reports. [Accessed 12th September 2017].
- Bhavnani V, Fisher B, Winfield M, Seed P. How patients use access to their electronic GP record—a quantitative study. Family Practice. 2011; 28 (2): 188–94.
- Fisher B. Patients’ access to their electronic record: offer patients access as soon as you can. British Journal of General Practice. 2013; 63 (611): 423–5.
- Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JG. The Cochrane Library. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Available from: cochrane.org/CD007228/VASC_structured-telephone-support-and-non-invasivetelemonitoring-management-people-heart-failure. [Accessed 3rd November 2017].
- McKinstry B, Hanley J, Lewis S. Telemonitoring in the management of high blood pressure. Current Pharmaceutical Design. 2015; 21 (6): 823–7.
- Gretton C, Honeyman M. The King’s Fund. The digital revolution: eight technologies that will change health and care. Available from: https://www.kingsfund.org.uk/publications/eight-technologies-will-change-health-and-care. [Accessed 7th September 2017].
- Operations cancelled as cyber attack hits NHS Lanarkshire hospitals and GPs. Available from: http://www.bbc.co.uk/news/uk-scotland-glasgow-west-41048568. [Accessed 3rd November 2017].
- Caldicott F. Review of data security, consent and opt-outs. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/535024/data-security-review.PDF. [Accessed 6th November 2017].
- Commons Select Committee. Action needed on digital skills crisis. Available from: https://www.parliament.uk/business/committees/committees-a-z/commons-select/science-and-technology-committee/news-parliament-2015/digital-skills-crisis-report-published-16-17/. [Accessed 6th November 2017].