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.
Name: Carl Plant
Position: Director at Bitjam
Carl is a director with a unique skill set. He originated as an NHS practitioner, with a background in creating technology and software applications, from web development to building high-impact and secure software solutions for public sector organisations. As director of Bitjam, Carl fuses his experience in frontline healthcare with his avidity for technology and a passion for creating solutions that have social benefit.
How did you merge your experience as a healthcare worker with your enthusiasm for complex software development to found Bitjam?
Most of my earlier digital work was building websites and applications, using very early – almost primitive – technologies compared to today. Much of my early work, especially in health and data visualisation, I began to share through a blog. I then got involved in the open data movement looking at ways to turn data from spreadsheets into stories or applications such as maps and graphs.
During early 2005 I was successful in getting the position of National Development Officer (NDO) for the UK Association for Solution Focused Practice (UKASFP). While developing the platform and building an online community I got the chance to develop a website for an NHS Mental Health Crisis resolution team. Soon after I began to work on numerous digital projects including an online support platform for people with learning disabilities which tested the ability to build accessible web applications. Meanwhile my datablog was attracting support, presenting opportunities to present and consult with the Royal College of Nurses, National Institute for Healthcare and Excellence (NICE), Nursing and Midwifery Council, marathon open data hacking sessions at The Guardian plus numerous health data hack sessions around the UK.
What advantages did this experience give you to develop Bitjam in to a niche software solutions company for public sector organisations?
Over the years I’ve led on many digital projects in the public sector, working through the challenges of creating a solution that solves the problem at hand, rather than making a solution fit a problem. Understanding the barriers to adoption is a key learning point, using an agile approach that works closely with the end users, and not being afraid early in the project to reject assumptions.
Bitjam prides itself on working with organisations and projects that have a social benefit. As director, why is this important to you?
I used to work in a company that made wiring harnesses for the military, I left this career to work with people, to make a difference to society and that need has stuck with me. This led to working with those with learning disabilities, then on to Mental Health as a nurse after going back to University. This need to do good remains with me today, I’m driven by the desire and understanding that digital technology can improve the lives of people. I see lots of companies who only see health tech as a commercial opportunity and you can see the effect that has on the products, when they don’t achieve the desired outcomes. I believe I can find the balance between creating a strong business while achieving good outcomes for society.
Bitjam’s tagline is “Developing technology from small ideas to global growth”. How do you achieve this using co-production techniques and agile methodology?
We work in partnership, walking side by side with our partners. I guess it’s my nursing experience that allows me to listen and develop equal relationships with clients. I believe the clients and the users of a digital services are the experts in their sector or life experiences and we need to tap into that rich resource. This isn’t always easy especially when working with marginalised groups, or people who have accessibility barriers to breakthrough.
We have expertise in how technology can be wired together and deployed, we can only create success by working in this close relationship with a shared set of goals with the users of the service.
I believe it’s important to allow flexibility in the development process, to allow testing and revision, and crucially, to allow your assumptions to be challenged.
After spending many years working with technologies and keeping on top of newer stable versions, and importantly having fantastic staff, we have the ability to launch solutions to scale, in some cases taking them global.
What do you think is crucial for digitalising the healthcare sector in the future?
Sometimes the best solutions are simple, they perform a singular task and perform it very well. We see the opportunity for emerging technologies like AI, VR etc. These will only work if they are designed for a specific purpose and not off-the-shelf solutions designed for other sectors bent to look like it solves a problem in health. Also as Clay Shirky once said, “Communications tools don’t get socially interesting until they get technologically boring”, this is true with many technologies.
We must not shift our focus too heavily on new technology and forget that older technology such as SMS and MMS provide perfect means of building effective solutions. Lastly, we have been sidetracked by Big Data and having been overlooking small data we use daily in datasheets, databases etc. We have yet to fully harness small datasets, and we need to continue connecting systems together. I believe the work that NHS Digital are doing to improve interoperability is key.
If Carl’s history and experience are suited to your own healthcare technology project, you can get in touch by sending an email here. He’s always got the kettle on!
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.