Digital health apps offer new technologies to help a growing and aging population self-manage increasingly complex conditions and comorbidities. Patients demand empowerment to enable them to manage their treatment more independently. Such developments, from the very straightforward to more indepth solutions, can result in lower treatment costs to the patient and the NHS.
This series of blog posts will focus on behavioural activation and the way that the adoption of digital health applications can assist with such an approach to treatment. We will consider:
- the rise of app-reliant health support – how Healthcare Professionals manage and navigate through the apps available, clinician prescribed VS patient choice
- how developers build apps that conform to standards
- the difference between informing and changing – striking the balance between giving accurate and useful information
- providing the means to help patients change behaviours based on ‘The States of Change’ model
The first part in the series will focus on the increasing number of apps available on the market and how HCP’s are dealing with this.
Conforming To the New Norm
Smartphones allow the industry to create apps that are an extension of patient treatments, outside of the doctor’s surgery. They’re designed to push the right information to the right person at the right time.
App developers must conform to health app criteria as outlined by gov.uk. There must be evidence that the apps improves outcomes for patients and users, provides value for money, meets user needs, and is stable and simple to use.
“All apps must be clinically safe: this means that they they’re safe for people to use – not just for healthcare professionals and patients but everyone involved in creation, testing and approval of the apps.”
Apps must capture and handle data sensitively, legally and securely, and usability and accessibility must be considered to mean the app is inclusive of those with disabilities or those with a limited technical knowledge.
Should Healthcare Providers Prescribe Apps or Let Patients choose? Or both?
On the other side of the coin is the recommendation and administration of such apps from HCP’s. The NHS released the NHS Apps Library last year, accessible to the public to help them make informed choices about the apps they choose. This is the one of the early stages of patient empowerment during treatment as the notion of choice stimulates positive behaviour activation.
HCP’s can refer to the Apps Library to help provide better informed recommendations, as each app has been quality standardised and is compliant according to the NHS.
Some apps are labelled, NHS Approved meaning those select few meet NHS quality standards for clinical effectiveness, safety, usability and accessibility and are backed by strong evidence supporting improvement of patient outcomes
However with over 165000 health apps currently in circulation in app stores it’s equally as easy for a patient to “self-diagnose” which can of course present many dangers.
Some HCP’s remain reluctant to adopt their use in clinical practice
The vast majority of digital health apps available from app stores aren’t certified by the NHS, therefore they’re without the thorough understanding of risks and benefits. A patient might discover an app that they’re confident will assist with their treatment. The purpose of an app is to provide quality and safety with accurate information and guidance to the end user in order to improve patient outcomes, but unlike medication such treatments aren’t scientifically measured, so if it’s not approved by the NHS, it’s generally at the HCP’s discretion whether to approve its use for their patient, which can be problematic.
Disruptive. In a Good Way
Mobile Health – AKA “mHealth”- has notable benefits globally, especially in developing areas of the world. Countries such as Africa are emerging with “ a great deal of innovation, because the need for low-cost solutions for pressing health issues has generated much experimentation and research that is likely to play a role in more advanced economies in the coming years
The distribution of a physical pill as part of a patient’s treatment, despite rigorous scientific testing, can still never assist with certainty in improving patient outcomes. As the world becomes immune to antibiotics it seems practical and imperative that another solution be brought to the doctor’s office. Unlike traditional medication, mobile apps have greater potential to assist with behaviour activation, as it encourages the patient to educate themselves by becoming actively engaged with a non-invasive treatment method.
In a previous blog post we discussed interoperability in healthcare and why electronic data such as EHR’s need communication improvements in order to function more effectively. We also discussed the NHS at 70 and the ways in which digital can be adopted into the wider healthcare sector to ensure another successful 70 years of the National Health Service.
“Interoperability is the extent to which systems and devices can exchange and interpret shared data. In healthcare, effective interoperability occurs when IT and software systems exchange shared data to create information that can be used to assist clinicians and other medical professions with patient care.”
Digital health apps have the potential to improve interoperability, as longer as there’s focus on training efforts, and apps that need to communicate with clinical systems must be compliant with the relevant technical standards.
At Bitjam we’ve recently developed an app called BeAble, with Combined Healthcare that bridges the gap between one-to-one appointments and discharge, enabling mental health patients to effectively manage their aftercare without the need for more appointments. The app is in phase two of testing, and each user has been given adequate training to use and administer it to the patient. Find out more here.
Next week we’ll be following up with a discussion about the difference between informing and changing patient outcomes, providing the means to help patients change behaviours based on The Transtheoretical model.
In the meantime if you want to discuss any of the matters surrounding patient empowerment, behaviour activation and digital health applications drop us an email for a chat.
Clinicians and healthcare practitioners making a contribution every day to innovation in healthcare heavily influence our own work at Bitjam. With the NHS now in its 70th year, we’ve highlighted three key points that we believe will be the backbone for the future of the NHS, with particular focus on grass-roots innovation and discoveries that start with frontline staff.
Innovation is Imperative to Continuing NHS Success
Research shows that as a nation we’re getting healthier and living longer, but the demand for NHS services are increasing and becoming more complex. The Five Year Forward View has a focus on strengthening access to high quality GP services and primary care – the largest point of interaction that patients have with the NHS. Digital innovation is key to bridging the gap between demand and quality GP services.
A key point to make is that digital and technology transformation in the NHS has revolutionised patient interaction. Digital technologies have seen a shift in the way people are choosing to transact. Consumers are voting with their fingers rather than their feet, choosing to transact via mobile apps rather than retail parks and high streets. This also translates to healthcare – there is a demand for convenience such as online GP appointment booking. With a growing demand for appointments, and the technology available to provide such a facility, this is a clear example of the importance of digital innovation.
Frontline Healthcare Workers Need Support for Innovation
Digital innovation needs to be wrapped around the needs of patients. Truly innovative approaches to improving care and/or improving efficiency through technology often start on the frontline. Healthcare workers who take care of the general public and use the systems created to support them on a daily basis, making them the most qualified to make suggestions for innovation. They understand what people want, look at the evidence and get a strong business case. They are most willing to roll up their sleeves and actively make beneficial changes to systems and platforms to improve patient care.
We believe that a modern NHS means clinicians need to be more tech-savvy than ever before, to be able to understand how to respond to gaps in facilities that could be bridged with technology and digital innovation. With the support of the NHS Innovation Accelerator (NIA) – an NHS England Initiative delivered in partnership with Academic Health Science Networks (AHSN) – clinicians are gaining the confidence to recognise gaps and present innovations that bring greater patient benefit.
Technology for Improving Patient Care Pathways
There’s a lot of media coverage on data protection, but patients are happy to share their data when they know it’s for their own care. Focusing on building secure patient systems will increase their trust and confidence in how data is used in order to engage people in a way that resonates with them.
Our recent work with BeAble – a post-discharge system designed to improve patient-clinician relationships and the promotion of patient wellbeing – is an example of improving patient care pathways as it offers an effective solution to the problem of co-morbidity and poly-pharmacy. You can read the full case study here.
The Next 70 Years of the NHS
In the future we want to see more support for health professionals and not just through the entrepreneur leadership programme but also on the frontline, with basic digital awareness and training. Such training reduces the problems found in interoperability within healthcare as everybody receives greater levels of training.
At Bitjam we like to think that the future of digital and technology innovation in healthcare is a system built on recognition and response. We want our solutions to help everyone – patients and professionals alike – ensuring inclusivity, equality, diversity and control. We believe that the NHS at 70 shares these values and we’re looking forward to contributing the technology that supports all users of this unique healthcare system.
A patient with more than one condition – diabetes AND kidney disease for example – with several life-changing symptoms, requires them to take lots of medication that might have multiple side effects. Such difficult health conditions can be challenging to live with and some people find it hard to deal with the pressure, especially when patients are discharged or in-between services.
Combined Healthcare realise that many long-term sick patients aren’t simply somebody with one condition – they tend to have a number of health areas that they would like to manage better. This can be a frustrating experience for the patient, as often the information is not readily available, and they might also have to deal with polypharmacy if they are being passed to different services. It’s equally as challenging for the clinician, as they lack the time and resource to give the patient the full care they require.
This is why the idea for BeAble was born. A post-discharge system that provides the clinician with a library of more specific illnesses and treatments that aren’t just pulled in from NHS Choices(our research has considered this to be too long-winded and not specific enough). The library also provides the clinician with ideas for therapeutic activities to encourage a more active and happy patient. The patient is then provided with personalised information and a tailored plan about how to manage their conditions post-discharge, to stop relapse-prevention.
Bitjam are building two parts to the BeAble system – a mobile app and web platform from which clinicians will be granted access.
BeAble will have a number of core features, including a library of specific information and intervention suggestions for clinicians, written in a way that patients will understand, as well as encouraging patient control as they will have the opportunity to be more active about their condition (behaviour activation). Patients will have their care plan accessible from their mobile phones which will have the ability to connect with other technologies such as Amazon Alexa and Google Fit, enhancing the user experience by linking with apps that are useful to their ongoing recovery.
At the heart of BeAble is the idea of supporting patients who might be between many services or post discharge with the need to provide relapse-prevention support, to ensure patients are receiving quality and accurate care.
Patients will work more closely with their clinician to decide on appropriate therapeutic activities, which will help to establish and strengthen a relationship between clinician and patient. Any questions that the patient might have can be written in the app and up for discussion during appointment times. This is known as “channel shift” and it’s shown to improve communication. Patients can message as and when they need to. Channel shift could be the beginning of a move away entirely from the traditional appointment times as the idea is to reduce the number of necessary appointments with accuracy.
Issues such as poly-pharmacy can be tackled using a service like BeAble, to decrease the chance of patient relapse-prevention. Poly-pharmacy is an increasingly common phenomenon that demands attention at clinical level as it can threaten rather than improve a patient’s wellbeing if it’s not managed effectively.
Technologies such as BeAble can ensure best practice in medication management and enhanced self care which are fundamental to independent living with multiple long term condition.
Technology for Social Good
At Bitjam we prefer to choose projects and work with clients in the public sector such as healthcare and education. It’s not only an area we’re more familiar and have more experience in as a collective set of skills, but fields that we have personal preference for as we are contributing towards improving societal communication. You can read more about our projects on our portfolio page here.
If you would like to talk about BeAble, more of our “social good” projects or if you have an idea for a communications project yourselves then you can also drop us an email to chat here.