The NHS must adopt the operating models of the digital economy—not just its productsby William Mosseri-Marlio / May 26, 2016 / Leave a comment
The $13.1 billion mobile health market is growing at breakneck speed. The number of UK health app users doubled in the last two years; for wearable health technology, usage tripled.
This growth is easy to explain. Asthmatics can now use monitoring apps to gain a better understanding of what triggers their symptoms. Diabetics no longer need to prick their finger to measure their glucose levels—non-invasive wearables are now on the market.
As a paper published by Reform today notes, this presents a significant opportunity for policymakers. Those with low health literacy have poorer health, go to hospital more frequently and are less likely to use preventative services. Apps and wearables could harness the powerful role patients play in their own health, encouraging more effective self-care but also helping patients stay healthy in the first place. A randomised control trial in America, for example, found a diet-and exercise-monitoring device helped consumers lose an additional 3.9 kilograms over a 12 month period. Given the annual cost of obesity to the NHS stands at £5 billion, even marginal improvements in patient behaviour could deliver meaningful savings.
However, while consumers are turning to apps and wearables in increasing numbers, new data from Accenture—the management consultancy service—suggests the utility of these tools is on the decline. In the UK, the number of people who say technology helps them understand their condition has fallen by seven percentage points—a trend replicated in Australia, America and Singapore. This should be of concern to an NHS placing considerable weight on digital self-care to manage demand and reduce costs.
A number of factors could explain this international decline. The explosion of information generated by apps and wearables might be creating more confusion than clarity, particularly in the absence of decision support. If user data is not shared with clinicians, consumers will see their products as less valuable.
In the UK, administrative issues have also been in play. The NHS has struggled to establish a framework to help consumers navigate the complex mobile health market. Its initial response was the Health Apps Library, a portal established in 2013 where products were given NHS backing, but this was closed following reports of data leaks. Policymakers have subsequently announced a new endorsement model whereby products are given an NHS stamp of approval if they pass through a four-stage process.
Worryingly, the NHS has admitted this new model only stands a 50 per cent chance of succeeding. The problem stems from the fact that the digital economy is highly fluid: products emerge, change the market, and then are usurped. An app may be obsolete before officials have had time to offer an assessment.
An alternative to this command and control approach would be for the NHS to adopt the operating models of the digital economy, and not just its products. Trip Advisor is a testament to the power of peer review, a technique which is being applied to increasingly complex fields. Rather than the traditional approach to academic publishing, whereby anonymous referees can hold up publication for years, the Faculty of 1,000 group allows biomedical researchers to publish papers provided a minimum set of standards are met. The network then encourages fellow academics to critique articles—and their underlying data—in a transparent and accountable way. Whether any given paper is taken seriously depends on the content and quantity of these reviews, but this flexible and responsive feedback loop has obvious benefits that could be applied to the digital health market.
For policymakers, resolving this challenge is pressing. The mobile health market is expected to grow by 33 per cent annually over the medium term, expansion that could bring yet more complexity and confusion. Unless a new framework is put in place to help clinicians and consumers navigate the market, the NHS will miss out on the benefits of patient engagement. Given the £22 billion efficiency challenge faced by the health services, these are losses the NHS can ill afford.
The future of public services: digital patients is available at www.reform.uk